Arthroscopic frozen shoulder release

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1 Patient Advice and Liaison Service (PALS) King s Mill Hosp ital Newark Hospital Arthroscopic frozen shoulder release Patient information If you need this information in a different language or format, please contact the Communications and En gagement Team on or Leaflet code: PIPR004(v1) Created: June 2010 / Review Date: June 2012 Website: 12

2 Aims of this booklet This booklet will help you familiarise yourself with the problem in your shoulder and the operation you are to undertake. It will help you understand what will happen on the day of your operation and what to expect after the operation. There is also a short section on the risks and possible complications associated with the procedure. Introduction The shoulder joint has a capsule around it to stabilise it. This capsule can sometimes become scarred and tight, restricting the movement in the shoulder. This is called frozen shoulder, or adhesive capsulitis. The surgeon can cut through the scarred tissue from the inside, and then manipulate the shoulder to improve the range of movement. Useful contact details If you require any further information please contact: Pre-op Assessment King s Mill Hospital extension 4213, 6638 or 4214 Day Case Unit King s Mill Hospital extension 3195 Further sources of information ructuredview/treatments 2 11

3 reaction to pain medication. Your GP should be contacted in this case. There is a small risk of significant bleeding. If this happens, you may need to stay in hospital a little longer so that pressure dressings can be applied to stop the bleeding. There is a small risk of injury to a nerve. If this happens, you may have temporary or permanent numbness or weakness in your arm or hand. This is very rare. There is a small risk of injury to a blood vessel. This may result in bleeding. Very rarely surgery may be needed to prevent complications because of lack of blood. It is possible to break the arm bone (humerus) when manipulating the shoulder at the end of the operation. The surgeon is very careful to avoid this, so it is rare for it to happen. There is no guarantee that the operation will work. It is successful in about eight out of ten people. Rarely, patients find their symptoms can be worse after surgery. There is no guarantee the operation will be a permanent cure, and there is always a possibility of needing further surgery in future. Your arm may be stiff after the operation. It is very important to follow the physiotherapists advice in the weeks after the operation to prevent permanent stiffness. 10 During the two weeks before your surgery You will attend pre-op assessment for routine observations and/or investigations depending on your age and health. You will also see your surgeon to discuss your operation and sign your consent form. Before surgery you may be asked to stop taking drugs which make it harder for your blood to clot. These include warfarin, clopidogrel, dipyridamole, aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs. You will be informed at your pre-op assessment appointment which of your drugs should be stopped and when to stop them. If you have diabetes, heart disease, high blood pressure or any other medical condition, your surgeon may ask you to see the doctor who treats you for these conditions. This is to make sure they are under control and will not delay your operation. Tell your doctor if you have been drinking a lot of alcohol, more than one or two drinks a day. If you smoke, try to stop. Ask your doctor or nurse for help. Smoking can slow down wound and bone healing. Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery. 3

4 What happens on the day of surgery? You will usually be asked to attend the Day Case Unit, which is on level 0 of tower 1 (blue tower) King s Mill Hospital, at 7.30am on the morning of your operation. This is so we can check that everything is ready, and the anaesthetist can see you before the operation. The anaesthetists are doctors who provide the anaesthetic for the operation. They will ask you some questions about your health and discuss with you the anaesthetic options. This operation will usually be done under a regional anaesthetic (block), which means the arm is numbed by a carefully placed injection in the base of the neck on one side. This prevents you from feeling any pain during the operation. You will also have the option of sedation in addition to the regional anaesthetic. This makes you very sleepy, and most people will fall asleep during the operation, but it avoids many of the risks and side effects of a full general anaesthetic. Sometimes the anaesthetist may recommend a full general anaesthetic (putting you to sleep). The operation itself will usually take about 45 minutes. When it is time for your operation, you will be taken down to the theatre reception area, and then to the anaesthetic room, where the anaesthetist will provide the anaesthetic. You will then be taken to the operating theatre itself. We will arrange to see you in clinic again six-eight weeks after your surgery. Outcome Patients experience improvement to their symptoms over the subsequent months following surgery and between percent have full or significant symptomatic recovery within six months of surgery. Are there any risks associated with this procedure? There is a small risk of infection. If this happens, the operation site will become red and inflamed. There may be some pus and you may feel generally unwell or feverish. If this happens, see your GP as you may need antibiotics and sometimes another keyhole operation to wash the inside of the joint. Contact your GP if: drainage continues from the wound for more than 24 hours after surgery redness or foul odour develops around the wounds pain cannot be controlled by medication your temperature rises above 101 F (38.3 C). Prolonged nausea and vomiting may be a sign of adverse 4 9

5 You should apply ice for at least 20 minutes about three times a day. Ice should not be placed directly on the skin. Place a moist towel on the skin and apply ice in a plastic bag directly over the towel. Do I need to wear a sling? The sling is for comfort only. You do not need to have your arm strapped to your body. You may find it helpful to wear the sling at night, with or without the body strap, for the first few nights, particularly if you tend to lie on your side. Alternatively you can rest your arm on pillows placed in front of you. If you are lying on your back to sleep you may find placing a thin pillow or small rolled towel under your upper arm will be comfortable. What happens afterwards? You should see the nurse at your GP surgery two weeks after the operation to check your wounds have healed and remove any stitches if necessary. Depending on the type of job you do, you may be able to return to light duties at this stage. Return to driving and work is usually possible about four weeks after your surgery. When you feel that you could safely swerve in an emergency, you can return to driving. 8 You will be placed on an operating table, which will be adjusted so you are in a sitting position. The theatre staff and surgeons will make sure you are comfortable. Your head will also be secured. There will be a member of staff with you at all times. The surgeon will draw on your shoulder with a marker pen to help him/her decide where to place the keyhole incisions. He/she will inject a small amount of local anaesthetic and adrenaline into the shoulder, mainly to reduce bleeding during surgery. The surgeon will then go and scrub up and put on an operating gown. During this time, the theatre nurse will paint your shoulder and arm with antiseptic to prevent infection. A clear plastic sheet will be placed over your shoulder to keep the shoulder area sterile. If you have not had the sedation option, you will be able to watch the operation on a television 5

6 screen. The surgeon makes two small cuts on the shoulder, about half an inch (1cm) long and will insert a telescope into the shoulder. Through the other hole, the surgeon can insert various surgical instruments. The operation involves cutting through the scarred shoulder capsule from the inside. This is done with a tiny electric burning stick (diathermy). The diathermy also helps stop bleeding. If the operation cannot be done through the keyholes, a slightly bigger incision may be necessary. When the surgeon has cut through the scar tissue, he/ she will carefully force the shoulder through a normal range of movement in order to tear any remaining fibres. 6 When the operation is finished, the surgeon will close the wounds with steristrips (butterfly stitches) and a sterile dressing. Sometimes, proper stitches are also required. Your arm will be put in a sling for support. After the operation, you will be taken back to the day case unit. As long as there are no complications, you will go home the same day. It is vital that you practise moving the arm through a full range of movement straight away. It may be painful at first, but will gradually ease. If you do not do this, the capsule will scar up again and your shoulder will remain very stiff. The physiotherapists will show you what to do before you leave. After the surgery You will be provided with pain relief in the form of tablets after your operation. You may also be given some to take home. If you had a shoulder nerve block in your neck before the operation, this will give you up to 16 hours of pain relief after the operation. Ice may be applied to the shoulder to control pain and swelling. Excessive swelling increases pain and may increase scarring, which in turn will tend to cause stiffness in the joint. 7

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